#1. TORTICOLLIS

Question 1

What is Torticollis?

Answer 1

• PERMANENT LATERAL bending of the Head + Neck
• Causing Facial Asymmetry

Question 2

What are the 2 MAIN TYPES of Torticollis?

Answer 2

1) Congenital

2) Acquired

Question 3

What are the SUBTYPES TYPES of CONGENITAL Torticollis?

Answer 3

• 1) MUSCULAR = Tight + Shortened Sternocleidomastoid Muscle - DUE to Pressure on SCM from ABNORMAL Positioning of Fetus (Uterus)
• 2) OSSEO-ARTICULAR = Accessorial, Cuneiform, or Fusion Vertebrae; a SHORT Neck
• 3) NEUROGENIC = SPASTIC PARALYSIS of the ACCESSORY Nerve

Question 4

What are the SUBTYPES TYPES of ACQUIRED Torticollis?

Answer 4

• 1) CUTANEO-CICATRICIAL Form = Wounds / Burns of the Skin, causing Neck Distortion
• 2) Acquired MUSCULAR Torticollis = Rheumatoid / Infection Disease of SCM / Trapezius
• 3) NEUROGENIC Acquired = PAINFUL SPASMODIC Torticollis, causing PERMANENT Neck Distortion (Cerebral Palsy)
• 4) HABITUAL Torticollis = FORCED TILTED Positions (Dentists)
• 5) OSSEO-ARTICULATIONAL Torticollis = Bone / Articular Damage by TB / Rheumatoid Arthritis / Osteomyelitis or Tumours

Question 5

What is the ETIOLOGY of Torticollis?

(The Theories)

Answer 5

1) MECHANICAL Theory
- Foetal Malposition during Intrauterine Development - there’s PRESSURE on Umbilical Cord on Neck, thereby shortening muscles

2) DYSPLASIA Theory
- Muscular Dysplasia, DURING Embryogenesis

3) ISCHAEMIC Theory
- FIBROSIS / SCARS of Muscle, occur due to Ischaemia / Thrombosis of AFFERENT Vs

4) INFLAMMATORY Theory
- FIBROSIS / SCARS of Muscle, occur due to Inflammatory Processes of BACTERIA

5) HEREDITARY Theory
- Genetic Mutation, causing deformity

Question 6

What is the PATHOGENESIS of Torticollis?

Answer 6

1) There’s SPINDLE-like THICKENING of Sternocleidomastoid Muscle

2) Line of the CICATRICAL (Scar) Tissue is OUTLINED, by Healthy Tissue

3) Muscles are Shortened, WITHOUT Haematoma

Question 7

What are the CLINICAL FEATURES of Torticollis?

Answer 7

• SCM is SOLID, when palpated
• Spindle-like thickening TUMEFACTION on MIDDLE / LOWER part of SCM
• If Trapezius Muscles are involved, the face ROTATES laterally + Upwards
• IPSILATERAL Face, leading to Facial Asymmetry

Question 8

What are the TREATMENT for Torticollis?

Answer 8

CONSERVATIVE Tx

• Done at Ages 1-2 Years Old
• GENTLE MASSAGING of the shortened muscle = FOR Elongation / repositioning
• Bandage Collar of SCHANZ

SURGICAL Tx

• IF SEVERE deformities, after 3rd Month
• IF Conservative tx is unsuccessful
• CUT off BOTH PEDICLES of SCM, and place ONTO Clavicle / Sternum
• MINERVA CAST for 30-45 Days = IF Head is tilted to Opposite (Healthy)